20160680 Ver 1_Application_20160711

Carpenter,Kristi
From:
McHenry, David G
Sent: Monday, July 11, 2016 7:37 AM
To: Beckwith, Loretta A SAW; Chapman, Amy; Carpenter,Kristi; Barnett, Kevin; Andrew
Henderson ([e-mail]); Chambers, Marla J; Dockery, Jacob A;
Subject:
Attachments:
Ladies and Gentlemen,
DeWit, Benjamin J
NCDOT, SR 1305 Nationwide Permit 3 Application
NCDOT_SR 1305 Qualla Road_Clay County_NWP 3 Drawings and Pictures.pdf;
NCDOT_SR 1305 Qualla Road_Clay County_NWP 3 Package.pdf
Please accept the attached application for a Nationwide 3 Permit for culvert work under SR 1305 in Clay County. Please
advise me if you have any questions or need any further information.
ThankYou
Dave McHenry
Environmental Specialist
NC Department of Transportation/Division 14
828 586 2141 office
828 246 -7078 mobile
dqmchenrvCa�ncdot.qov
253 Webster Road
Sylva, NC 28779
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Cmail correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties,

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name: SR 1305 — Qalla Road RepavinQ
2. Name of Property Owner/Applicanr North Carolina Department of Transportation (NCDOT)
3. Name of Consultant/Agent:
•Agent authorization needs to be attached.
4. Related/Previous Action ID number(s):
5. Site
6. Subdivision Name:
7. City: Havesville
8. County: Clav
9. Lat: 35.051182°N Long: -&3.845050 ° W(Coordinates at Project Center) (Decimal Degrees Please )
10. Quadrangle Name: Hayesville (35082-A7-TF-024)
1 I. Waterway: Sweerivater Creek, Oually Creek, and UTs (WS-N2
12. Watershed: Hiwassee River (HUC 06020002)
13. Requested Action:
X Nationwide Permit # 3
General Permit #
_ Jurisdictional Deteimination Request
_ Pre-Application Request
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Puipose:
Site/Waters Name:
Keywords:
•ti

�` ;
PAT McCRORY
Gmenmr
NICHOLAS J. TENNYSON
Sruernq
Transportation
July 1 I, 2016
Ms. Lori Beck�vith, NCDOT Regulatoiy Project Manager
U.S. Army Corps of Engineers
I S l Patton Avenue, Room 208
Asheville,NC 28801-27L4
Subject: Nationwide 3 Permit Applic�tion
Repave Qualla Road (SR 1305) fi�om US 64 to Tusquittee Road (SR 1307)
Sweetwater G�eek, Qually Creek, and UTs, Clay Counq�
State Project No. 14.202211 (DWQ Minm• Permit Tee $2d0)
Dear Ms. Beck�vidi:
The No�th Carolina Department of Transportation (NCDOT) is proposing to replace and extend
culveits in S�veehvater Creek, Qually Creek, and UTs beFore repaving Qualla Road (SR 1305) in
Clay Count��. The roadway is not being widened, but the culvert work is needed due to the poor
condition of the esisting pipes and because the road sltoulders are narrow and a hazard to drivers.
ln addition, it will be necessary to relocate a 106' section of Qually Creek where the sh�eam
channel is eroding into the road filI and the shoulder is now only l-2 feet wide before dropping
sharply 10-L2 feet to Qually Creek below.
Enclosed ere � YCN �pplication, preliminaryjurisdictionaldetermination, photographs ofthe
project sites, the culvert diagrams, a marked vicinity map, a USGS topographic map, and other
suppoiting information.
The North Carolina Natural Heritage Program lists 38 species for Clay Counly that have federal
status and that are known from current or historical records. Three species, the green pitcher
plant (Sarracenia oreophiln), rock gnome lichen (Gpn�o�mderrun liiiern•e), and the northern long-
eared bat (NLEB, dlyotis se�tentrionolis) m�e known from current records and are listed as
ei�dangered or threatened.
There are no records for listed species in the Sweehv�ter Creek and Qually Creek waterslieds.
�Vetlands and damp rock faces needed by gree�i pitcher plant and rock gnome lichen,
respectively, are not present in the project area. Por these reasons and due to the limited scope of
the work, the project should have "no effect" on these listed terrestrial species.
Clay County is considered occupicd habitat aud poteuti�l habital for northern long-eared bat
(NLEB, ildyolis sep�e�ln•ionnlis) and Tndiana bat (1Ylyolis sorlalis), respectively. These bats use
caves and mines for ���inter l�ibernacula and roost in structures or on trees with loose bark or
crevices in the spring to early fall. There are no caves or mines evident near the site, but there is
one large (26" dbh) double-trunked poplar tree that needs to be removed because it ltas grown
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SR 1305, Clay County Page 2 July 11, 2016
over the inlet of tlie culveit at Site 17. Tliere are a black cherry tree and a black walnut tree near
the poplar, but they should be avoided. The poplar and adjacent trees do not have loose bark or
crevices that might be suitable for bat roosting (see attached photographs at Site 17).
According to tlie USFWS Aslieville Field Office's website, the project site does not fall within an
area wliere prosimity to NLEB hibernacula or maternity roost sites might be a concern.
Therefore, we believe that tlie project sliould qualify for tlie exception from Nie incidental take
prohibition for NLEB under the Final 4d rule. If necessa�y, the poplar tree will be removed
outside of the October I S to April 15 period (winter clearing). However, as discussed with Mr.
Audrew Henderson of USFWS, we �vould like to complete the paving �vork earlier in late
summer-fall and relief from the winter tree clearing requirement seems warranted based on the
lack of suitable roost liabitat on the tree. We recommend tliat a"may affect, not likely to
adversely affect" determination for Indiana bat apply to this project with caicun�ence fi�om
USFWS for the clearing exemption or if tlie tree is removed from October I S to April 15.
The project only involves replacing and extending culver[s and grading witliin an existing,
disturbed right-of-way and an easement situated in an active stream chamiel and banks. And, the
roadway is not being widened and there are no listed or eligible historic properties near the
project ai�ea according to NCHPO data (See Attachments). Tlierefore, there should be "no effect"
of the project on cultural resources.
Erosion control devices �vill be installed and maintained as necessary during construction. The
culveit inveits will be installed slightly below the existing stream bottoms where bedrock is not
encountered to minimize aquatic habitat impacts and to maintain the existing stream grade as
much as possible. The relocated sheam channel will be constn�cted in the dry to mimic the
natural stream channel morphology and the banks seeded and stabilized with coir matting and rip
rap (left bank only) before introducing stream flow at tlie npstream end. Areas of disturbed soil
will be quickly seeded and covered with matting and/or stra�v.
Impacts to Waters of the United States
Sweehvater Creek (Class WS-IV) and Qually Creek (Class WS-IV) are shown ou the USGS
topographic map as perennial streams and have sufficient flow to suppoit aquatic life. The
cliannels are �vell de5ned, lack rooted vegetation, and are composed primarily of sand, gravel,
and cobble. Sweehvater Creek flows appro�imately 2.5 miles to the Hiwassee River, which
meets the definition of a Traditional Navigable Water (T'NW). From the eastern end of the
project area, Qually Creek flows approsimately 0.12 mile to the Hiwassee River. For tliese
reasons, �ve believe that S�veehvater Creek and Qually Creek are Relatively Permanent Waters
and under the jurisdiction of the U.S. Army Corps of Engineers. In order to complete the project,
it will be necessary to impact Waters of the United States in the Hiwassee River Basin (HUC
06020002). Specifically, NCDOT is requesting to replace and extend con•ugated metal pipes in
Sweehvater Creek, Qually Creek, and UTs and complete a chamiel realignment on a section of
Qually Creek as follows:
Site No. Elcisting Candition Proposed Condition Net
Station Im acts
Site 4 35' x 36" CMP 45' x 36" CMP 10'
Site 4a Free Flowing Channel Temporary Dike 60'
Flow Diversion

SR 1305, Clay County Page 3 July 11, 2016
Site 6 2T X 30" CMP 40' x 30" CMP 13'
Site 6a Free Flowing Channel Temporary Dike SY
Flow Diversion
Site 7 31' X 36" CMP 45' X 36" CMP 14'
Site 7a Free Flowing Channel Temporary Dike 60,
Flo�v Diversion
Site 7A 29' x 24" CMP 40' X 24" CMP I 1'
Site 7Aa Free Flowing Channel Temporary Dike SY
Flo�v Diversion
Site l3 46' X 24" CMP 54' X 24" CMP 8'
Temporary Dike
Site 13a Free Flotving Channel Flo�v Diversion ��
Site 14 54' x 24" CMP 50' X 24" CMP -4'
Site 14a Free Flowing Channel Temporary Dike 65'
Flow Diversion
Site I S 62' x 24" CMP 62' x 24" CMP 0'
Site l5a Free Flowing Channel Temporary Dike 75,
Flow Diversion
Site 16 41' x 36" CMP 45' x 36" CMP 4'
Temporary Dike
Site l6a Free Flowing Channel Flow Diversion 60'
Site 17 58' X 24" CMP 64' x 24" CMP 6'
Site 17a Free Flo�ving Channel Temporary Dike 80,
Flow Diversion
Site l8 40' X 24" CMP 40' x 24" CMP 0'
Site 18a Free Flowing Channel Temporary Dike 55'
Flow Diversion
Site 19 3T x 36" CMP 50' X 36" CMP 13'
Temporary Dike
Site 19a F��ee Flo�ving Channel Flow Diversion 65'
Site 20 68' X 36" CMP 72' X 36" CMP 4'
Temporary Dike
Site 20a Free Flowing Channel Flo�v Diversion 90'
Site 22 40' X 36" CMP 60' x 36" CMP 20'

SR 1305, Clay Counry Page 4 July il, 2016
Site 22a F��e Flo�ving Channel Temporary Dike 75,
Flow Diversion
Site 23 36' x 24" CMP 50' X 24" CMP 14'
Temporary Dike
Site 23a Free Flo�ving Channel Flow Diversion 65'
Site 24 4 P X 36" CMP 50' X 36" CMP 9'
Site 24a Free Flowing Channel Temporary Dike 65'
Flo�v Diversion
Site 26 32' X 42" CMP 79' X 42" CMP 12
(*see note)
Site 26a Free Flowing Channel Temporary Dike 100'
Flow Diversion
Site 26b 106' Free Flowing 90' Relocated Stream Channel 106'
Channel with Rip Rap on Left Bank
Site 26c Free Flowing Channel Temporary Dike ** 150'
Flow Diversion ( see note)
'At Sire 26 ihe culvert inlet will be esrended 12' ��fiile the outlet of the e�isting culvert directly abWs the scction oCQually
Creek that will be relocated — ihere is no UT channel doxnslmam of !he cnlrert where iM1e culvert outlet wil I be estended.
•s77ie [emporary Flow diversion at Site 2Gc will be necessary only if the nea• channel cannot be constructed in ihe dry ndjacenf
to �he otd and s[abilized beFore in�roducing SUeam flow, as ptanned.
Total Permanent Stream Impact fm• Culvert Extensions 134'
Total Permanent Impact for Stream Channel Relocation 106'(16' loss)
Total Tempm•ary Stream Impacts fm• Dikes and Flow Diversions 1,245'
Permits Requested
NCDOT is lie�eby requesting authorization under Section 404 of the Clean Water Act to proceed
with the project outlined above. By copy of this letter, I am asking iVLs. Marla Cliambers,
Western NCDOT Revie�v Coordinator with the No��tli Carolii�a Wildlife Resources Commission
(NCWRC), to comment directly to you concerning the 404 Natiomvide Permit request.
I am also requesting authorization under Section 401 of tlie Cleau Water Act from the Noi4h
Carolina Department of Environmental Quality (DEQ), Division of Water Resow�ces.
If you have any questions or need additional information, please contact me at [phone].
Your early review and consideration of this request will be greatly appreciated.
Sincer �
i� ���
ave McHenry
Division 14 Environmental Specialist
Enclosiu•es

SR 1305, Clay County Page 5 July 11, 2016
cc: Ms. Amy Chapman, Division of Water Resources, DEQ, Raleigh
Ms. Kristie Lynn Carpenter, Division of Water Resources, DEQ, Raleigh
Mr. Kevin Barnett, Division of Water Resources — DEQ, Asheville
Mr. Andrew Henderson, Biologist, US Fish & Wildlife Service, Asheville
Mrs. Marla Chambers, Western NCDOT Review Coordinator, NCWRC, Albemarle
IVL•. Adam Dockeiy, PE, Division 14 County Maintenance Engineer, NCDOT, Clay
Mr. Ben DeWit, PE, Roadside Environmental Field Operatious Engineer, NCDOT

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PC Form
A. Ap licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authodzation
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certificatlon:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes ❑ No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coaslal counties. If yes, answer 1h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: SR 1305 — Qualla Road Repaving
2b. County: Clay
2c. Nearest municipality / town: Hayesville
2d. Su6division name: N/A
2e. NCDOT only, T.I.P. or State yyBS No. 14.202211
ProJect No:
3. Owner Information
3a. Name(s) on Recorded Deed: NoAh Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if Dave McHenry, Division 14 Environmental Specialist
applicable):
3d. Street address: 253 Webster Road
3e. City, state, zip: Sylva, NC 28779
3f. Telephone no.: 828-586-2141
3g. Fax no.: 828-586-4030
3h. Email address: [e-mail]
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Informatio� (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name: N/A
4c. Business name N/A
(if applicable):
4d. Street address: N/A
4e. City, state, zip: N/A
4f. Telephone no.: N/A
4g. Fax no.: N/A
4h. Email address: N/A
5. AgenUConsultant Information (if applicable)
5a. Name: N/A
5b. Business name N�A
(if applicable):
5c. Street address: N/A
5d. City, state, zip: N/A
5e. Telephone no.: N!A
5f. Fax no.: N!A
5g. Email address: NIA
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B. ProJect Information and Prior Project History
1. Property Identificatian
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 35.057182 Longitude: -83.845050
(DD.DDDDDD) (-DD.DDDDDD)
1c. Propertysize: acres
2. Surtace Waters
2a. Name of nearest body of water (stream, river, etc.) to Sweetwaler Creek and Qually Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: DWR Class: WS-IV
2c. River basin: Hiwassee (HUC 06020002)
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the lime of this
application:
The overall landscape in the area is primarily single family residences, forest, and small farms. The immediate vicinity of
the project includes the roadway, pastures, wood lols, and maintained lawns.
3b. List the total estimated acreage of all existing wetlands on the property:
None
3c. List lhe total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1500
3d. Explain the purpose of the proposed project:
The purpose of the project is to repave SR 1305 and repair road shoulders to improve safety.
3e. Describe the overall project in detail, including the type of equipment to be used:
NCDOT will repave SR 1305 aRer replacing and extending several culverts and relocaling a short reach of creek due to
road shoulder erosion. Track hoes, dump trucks, bulldozers, paving equipment, wate� pumps, sandbags, and various
hand tools will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for lhis property / � yes � No ❑ Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made7 ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N!A
4d. If yes, list the dates of the Corps jurisdictional determinafions or State determinalions and attach documentation.
N/A
5. Project History
5a. Have permits or ceAifications been requested or obtained for � Yes � No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file' instructions.
6. Future Project Plans
8a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

2. Wetland Impacts
If there are welland impacts proposed on ihe site, then complete lhis question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wefland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem ora
W1 ❑ P❑ T N/A N/A ❑ Yes ❑ Corps N/A
❑ No ❑ DWQ
2g. Total wetland impacts N/A
2h. Comments: N/A
3. Stream Impacts
If there are perennial or intermiitent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Siream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 slream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) i�Nn? other) (feet) feet)
S4 � P❑ T Culvert UT to Sweetwater � PER � Corps Z 10
Replace./Extension Creek ❑ INT � DWQ
S4a ❑ P� T Impervious Dike & UT to Sweetwater � PER � Corps 2 60
Flow Diversion Creek ❑ INT � DWQ
S6 � P❑ T Culvert UT to Sweetwater � PER � Corps 1 13
Replace./Ealension Creek ❑ INT � DWQ
S6a ❑ P� T Impervious Dike & UT to Sweetwater � PER � Corps � 55
Flow Diversion Creek ❑ INT � DWQ
S7 � P❑ T Culvert Sweetwater Creek � PER � Corps 2 14
Replace.lE�Aension ❑ INT � DWQ
Imperviaus Dike & � PER � Corps
S7a ❑ P� T Flow Diversion Sweetwater Creek � INT � DWQ 2 60
S7A ❑ P� T Impervious Dike & UT to Sweetwater � PER � Corps Z � �
Flow Diversion Creek ❑ INT � DWQ
S7Aa � P❑ T Culvert UT to Sweetwater � PER � Corps 2 55
Replace./E�ension Creek ❑ INT � DWQ
S13 � P � T Culvert Sweetwater Creek � PER � Corps 2 $
Replace.lE�ension ❑ INT � DWQ
S13a ❑ P� T Impervious Dike & Sweetwater Creek � PER � Corps 2 ��
Flow Diversion ❑ INT � DWQ
S14 � P � T Culvert Replace. Sweelwater Creek � PER � Corps 1 -4
❑ INT � DWQ
Impervious Dike 8 � PER � Corps
S14a ❑ P� T Flow Diversion Sweetwater Creek � INT � DWQ 1 65
S15 � P❑ T Culvert Replace. Qually Creek � PER � Corps 1 0
❑ INT � DWQ
S15a ❑ P� T Impervious Dike & Qually Creek � PER � Corps � 75
Flow Diversian ❑ INT � DWQ
S16 � P❑ T Culvert UT Qually Creek � PER � Corps 2 4
Replace./Extension ❑ INT � DWQ
S16a ❑ P� T Impervious Dike & UT Qually Creek � PER � Corps 2 60
Flow Diversion ❑ INT � DWQ
S17 � P❑ T Culvert UT Qually Creek � PER � Corps 2 6
Replace./Extension ❑ INT � DWQ
Page 5 of 12
PCN Form — Version 1.3 December 10, 2008 Version

S17a ❑ P� T �mpervious Dike & UT Qually Creek � PER � Corps 2 $Q
Flow Diversion ❑ INT � DWQ
S18 � P❑ T Culvert Replace. UT Qually Creek � PER � Corps Z �
❑ INT � DWQ
S18a ❑ P� T �mpervious Dike & UT Qually Creek � PER � Corps Z 55
Flow Diversion ❑ INT � DWQ
S18 � P❑ T Culvert UT Qually Creek � PER � Corps 3 13
Replace.lExtension ❑ INT � DWQ
S19a ❑ P� T �mpervious Dike & UT Qually Creek � PER � Corps 3 65
Flow Diversion ❑ INT � DWQ
S20 � P❑ T Culvert UT Qually Creek � PER � Corps 3 4
Replace./Extension ❑ INT � DWQ
S20a ❑ P� T Impervious Dike & UT Qually Creek � PER � Corps 3 90
Flow Diversian ❑ INT � DWQ
S22 � P❑ T Culvert UT Qually Creek � PER � Corps g 20
Replace.lE�ension ❑ INT � DWQ
S22a ❑ P� T Impervious Dike & UT Qually Creek � PER � Corps 3 75
Flow Diversion ❑ INT � DWQ
S23 � P❑ T Culvert UT Qually Creek � PER � Corps 2 �4
Replace.lExtension ❑ INT � DWQ
S23a ❑ P� T Impervious Dike & UT Qually Creek � PER � Corps 2 65
Flow Diversion ❑ INT � DWQ
S24 � P❑ T CulveA UT Qually Creek � PER � Corps 2 9
Replace./EMension ❑ INT � DWQ
S24a ❑ P� T Impervious Dike & UT Qually Creek � PER � Corps 2 65
Flow Diversion ❑ INT � DWQ
S26 � P � T Culvert UT Qually Creek � PER � Corps 3 12•
Replace./Er�ension ❑ INT � DWQ
Impervious Dike & � PER � Corps
S26a ❑ P� T Flow Diversion UT Qually Creek � INT � DWQ 3 100
S26b � P 0 T Fill Channel Qually Creek � PER � Corps 10 106
Relocation ❑ INT � DWQ
S26c ❑ P� T Impervious Dike 8 Qually Creek � PER � Corps 10 150
Flow Diversion ❑ INT � DWQ
3h. Total Permanent Stream Impact for New Culverts and Culvert Extensions 134'
Total Permanent Stream Impact for Stream Channel Relocation 106'(16')
Total Temparary Stream Impacts for Impervious Dikes and Flow Diversions 1,245'
3i. Comments:
The culveA at Site 26 will be extended 12 feet in the UT on the inlel end and 35 feet on the outlet end, which now directly
abuts the reach of Qually Creek to be abandoned for the stream channel relocation — there currentiy is no UT downstream of
existing culvert.
If needed, temporary dewatering is proposed, but not anticipated, at Site 26c if the new stream channel cannot be constructed
adjacent to old channel and stabilized in lhe dry before introducing stream (low.
Page 6 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody lype Area of impact (acres)
Permanent (P) or
Tem ora
01 ❑P❑T N/A
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4E Total opeu water impacts N/A
4g. Comments: N/A
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number ofpond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 N/A N/A N/A N!A N/A N/A N/A N/A
P2
Sf. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no: N/A
5i. Expected pond surface area (acres): N/A
5. Size of pond watershed (acres): N/A
5k. Method of construction: N/A
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require miti ation, then ou MUST fill out Section D of lhis form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Olher:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigalion (square feet) (square feet)
Tem ora im act re uired?
B7 ❑ P❑ T N/A N/A ❑ No N/A N/A
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Totai buffer impacts N!A N/A
6i. Comments: N/A
Page 7 of 12
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize fhe proposed impacts in designing project.
The minimal lenglhs of culverts are being installed in order to construct lhe project to meet current NCDOT safety standards.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Appropriate BMP's for erosion and sedimentalion control will be installed on lhe project prior to construcfion. Impervious dikes
and flow diversions will be installed in order to install the pipes in the "dr�% to prevent sedimentation of downslream aquatic
habitats. The stream relocation will be completed in the dry by constructing the new channel adjacent to the existing and
stabilizing it before introducing stream flow.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for � Yes ❑ No
impacts to Waters of the U.S. or Waters of ihe State?
26. If yes, mitigafion is required by (check all that apply): � DWQ � Co�ps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for lhis project? � Payment to in-lieu fee program (NC DMS)
❑ Permittee Responsible Mitigation
3. Complete ff Using a Mitigation Bank
3a. Name of Mitigaiion Bank: NC Division of Mitigaiion Services
3b. Credits Purchased (altach receipt and letter) Type N/A Quantity N!A
3c. Comments: N/A
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval lelter from in-lieu fee program is altachad. � Yes
4b. Stream mitigalion requested: 150 linear feet
4c. If using slream mitigation, stream temperature: ❑ warm � cool ❑cold
4d. Buffer mitigation requested (DWQ only): N!A square feet
4e. Riparian wetland mitigation requested: N!A acres
4f. Non-riparian wetland mitigation requested: N/A acres
4g. Coastal (lidal) wetland mitigation requested: N!A acres
4h. Comments: N/A
6. Camplete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of ihe proposed mitigation plan.
N/A
Page 8 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact wilhin a protected riparian buffer that requires ❑ Yes � No
buffer mitigaUon7
6b. If yes, then identify fhe square feet of impact to each zone of the riparian buffer that requires mifigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 N/A N/A 3(2 for Catawba) N/A
Zone 2 1.5
6f. Total buffer mitigation required: N!A
6g. If buffer mitigation is required, discuss what lype of mitigalion is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
N/A
6h. Comments: N/A
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes � No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: NfA ❑ Yes ❑ No
Page 9 of 12
PCN Form — Version 1.3 December 10, 2008 Version

2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Qoes fhis project require a Stormwater Management Plan? � Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The project is covered by individual NPDES Permit No. NCS000250.
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governmenPs jurisdiction is this project? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
attached7
4. DWQ Stormwater Pro ram Review
❑ Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply � ORW
(check all that apply): ❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan wiih proof of approval been
attached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Revtew
5a. Does the Stormwater Management Plan meet lhe appropriate requirements? � yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 10 of 12
PCN Farm — Version 1.3 December 10, 2008 Version

F, Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expendilure of public (federallstate/local) funds or the � Yes ❑ No
use of public (federal/state) land?
1 b. If you answered °yes" to the above, does the project require preparation of an
environmental document pursuant to lhe requirements of the National or State ❑ Yes � No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered °yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments: N/A
2. Violations (DWQ Requirement)
2a. Is the site in violalion of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 2B A200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered °yes° to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anlicipated future impacts) result in � yes � No
additional development, which could impact nearby downstream water qualily?
3b. If you answered "yes" to the above, submit a qualitative or quantitalive cumulative impact analysis in accordance with lhe
most recent DWQ policy. If you answered °no,' provide a short narrative description. This projecl is maintenance of
existing infrastructure without an increase in capaciry (e.g., no addilional traffic lanes), so it will not facilitate secondary or
cumulative development.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate lreatment meihods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or availabie capacity of the subject facility.
N/A
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will lhis project occur in or near an area wilh federally protected species or � Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � Yes ❑ No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have wntacied.
� Asheville
5d. What dafa sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Natural Heritage Data
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whelher your site would impact Essential Fish Habitat?
N/A—There are no marine or estuarine communilies wilhin the Blue Ridge Physiographic Province.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation � Yes � No
stalus (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
This project only involves maintenance paving and culvert work that are categorically excluded actions under NCDOT's
Cultural Resource Programmatic AgreemenL The project area is not near historic properties according to NC HPO data.
And, disturbance will occur within existing disWrbed road R-O-Ws or an easement consisting of an active stream channel
and banks.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes � No
8b. If yes, explain how project meets FEMA requirements: N/A
8c. What source(s) did you use to make the floodplain determinaiion? NC Floodplain Mapping Program
Dave McHenry
Division 14 Environmental Specialist � 7–/� �,�
ApplicanUAgent's Sign ure Date
AppflCanUAgent's P�inted Name (AgenCs signature is valid onty if an authorization letter from the
applicanl is provided.)
Page 12 of 12
PCN Form – Version 1.3 December 10, 2008 Version

Hayesville Quadrangl�e Map SR-1305 Qualla Rd. Pipes
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ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):7-a-zois
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
NC �epartmenl of Transporlation, Dave McHenry, Division 14 Environmental Specialist
253 Webster Road, Sylva, NC 28779
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
Repave SR 7305 - Qualla Road, Clay County
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC County/parish/borough: c�ar Clty: Hayesvi��e
Center coordinates of site (IaUlong in degree decimal format):
Lat. se.oei�sz °N; Long. -as.aasoso °W.
Universal Transverse Mercator. zao�os.�, aaazazo.s zo�e n
N8171@ Of Il@8f2St WafO�bOQy: SweehvaterCreekandQuallyCreek
Identify (estimate) amount of waters in the review area:
Non-wetland waters:
�zso linear feet: �-�o width (ft) and/or acres.
Cowardin Class: R3ue�
Stream Flow:
Wetlands: Na acres.
Cowardin Class: �a
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal: Na
Non-Tidal: Na

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
� Office (Desk) Determination. Date: 7-8-Zo�s
� Field Determination. Date(s): s-zs-2o�s
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
� Maps, plans, plots or plat submitted by or on behalf of the
applicanbconsultant: Ncoor
❑ Data sheets prepared/submitted by or on behalf of the
appl�nt/consultant.
Office concurs with data sheets/delineation report.
Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
� USGS NHD data
� USGS 8 and 12 digit HUC maps
❑✓ U.S. Geological Survey map(s). Cite scale & quad name: � z4k Hayes��ne
❑ USDA Natural Resources Conservation Service Soil Survey.
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
� 100-year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑ Aerial (Name & Date): or
� Other (Name & Date): sR �3oe cz�ana Roaa-��ne 2a, zo�s
� Previous determination(s). File no. and date of response letter:
� Other information (please specify):

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre-construction notification" (PCN), or requests verification for a non-reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicanYs acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWAjurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.

This preliminary JD finds that there "may be" waters of the United States on the
subject project site and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
Signature and date of
Regulatory Project Manager
(REQUIRED)
4
i
� cv,,�i�!�'/ � 7—//-/L
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

Estimated
amaunt of
aquatic Class of
resource in aquatic
Site Number Latitude Longitude Cowardin Class review area resource
4 35.04065 -83.86874 R3U61 60 linear feet Non Section 10
- non-wetland
6 35.04148 -83.86585 R3UB1 55 linear feet Non Section 10
- non-wetland
7 35.04139 -83.86485 R3U61 601inear feet Non Section 10
- non-wetland
7A 35.04316 -83.86034 R3UB1 55 linear feet Non Section 10
- non-wetland
13 35.04430 -83.85885 R3UB1 701inearfeet NonSectionl0
- non-wetland
14 35.04534 -83.85769 R3UB1 65 linear feet Non Section 10
- non-wetland
15 35.04565 -83.85427 R3UB1 75 linear feet Non Section 10
- non-wetland
16 35.04689 -83.85104 R3UB1 601inear feet Non Section 10
- non-wetland
17 35.04847 -83.84923 R3UB1 80 linear feet Non Section 10
- non-wetland
18 35.04982 -83.84756 R3UB1 55 linear feet Non Section 10
- non-wetland
19 35.05095 -83.84560 R3UB1 65 linear feet Non Section 10
- non-wetland
20 35.05190 -83.84364 R3UB1 90 linear feet Non Section 10
- non-wetland
22 35.05255 -83.83949 R3U61 75 linear feet Non Section 10
- non-wetland
23 35.05307 -83.83605 R3U81 65 linear feet Non Section 10
- non-wetland
24 35.05286 -83.83409 R3UB1 65 linear feet Non Section 10
- non-wetland
26 35.05421 -83.82700 R3UB1 100 linear feet Non Section 10
- non-wetland
26b 35.054325 -83.826781 R3UB1 1501inear feet Non Section 10
- non-wetland

bfiligution Servires
EI:\'IflONHENTnL OVALIiY
Yr1l MCCRORY
DONAI_D R. VAN DER VAART
July 7, 2016
Mr. Dave McHenry
NCDOT Division 14 Environmental Specialist
North Carolina Departmeut of Transportation
253 WebsterRoad
Sylva, North Carolina 28779
Dear Mr. McHenry:
Subject: biitigation Acceptance Lelter:
Division 14 Project, SR 1305 (Qualla Road) Culvert Replacements over Sweehvater Creek,
Qually Creek and UTs, Clay Cou��ty; WBS Element 14.202211
The pi�rpose of this letler is to notify you tLat Uie Division of Mitiga�ion Services (DMS) will provide the
compensarory stream mitigation for the suUject project. Based on the infommtion received on July 7, 2016, the
impacts are located iu CU 06020002 of the Hiwassee River basin in the Southern Mountains (SM) Eco-Region, and
are as follows:
Hi�vassee Sheam Wellands Buffer (Sq. Ft.)
06020002 Non- Coaslal
SIlI Cold Cool �Vam� Ripanan Zone I Zone2
Riparian Mmsh
Impucls 0 150.0 0 0 0 0 0 0
(feeUacres)
Tl�is impacl and associated nutigalion ueed were ucider projected by tl�e ATCDOT ni the 2016 impact data.
DMS will conunit to implement sufhcient compensTtory stream mitigation credits to ofiset Ihe impacts associated
wilh �his project as detem�ined by lhe regulatory agencies using the delivery timelu�e listed 'ui Sectiou F3.c.iii of the
In-Lieu Fee Instrument dated July 23, 2010. If the aUove referenced impacl amounts are revised, then this
mitigation acceptance letter will no longer be valid and a new uiitigation acceptance letter mill Ue required &om
DMS.
8420.
If you have aoy questions or need additional infomiation, please conlac( Ms. Beth Hannon at 919-707-
Siucerely,
� ��"�i
James B. ta ll
Credit Management Supervisor
cc: Ms. Lori Beckwith, USACE — Aslieville Regulatory Field ORice
Mc Adaui Dockery, P.E., NCDOT — Division 14 Macon-Clay Counties MaiNeuance Engineer
Ivis. L'utda Fit�atrick, NCDOT — PDEA
File: SR 1305 Culverf Replacements — Division 14
Slaleo(NottliCa�olina I F.nvironmtnlalQaality� A1iti8a�ionScrvia�;
1652 Afail Service Cenkr I 2�� W.lonxs Strm4 Suiie 300U I Ra�eigh, NC 27609-1652
9197W 5976 T

Piogtammatic Agxeement Cultutal Resources Scxeening Checklist
Project Numbexs: TIP: n/a FA: .,/a WBS: /f!2�y z�>
Project Name: /� � o( � Coun :
(,✓va�4 �o°i �aYC � G�A}+
Project Description: s,2 /3o.s /
�.f pj�v'etf in✓ol✓sS IYi�bo/ 5liou/c�./ r.•d'� S crn� a�rwi:. �'%�c /e��<[evapn'Y-
/ /
�e�'o�e Y� c✓i.• a� �i% ✓'oa�. �sr�n .✓•7f�r6�nca t�i%� �� //is,ifto� � �ie
Funding Sourc� .� Permits Required: „�ib.r�,,; e /
ZS7�oft %�e.-m,-t ,3 C�'iJfihf /2-o-G✓ e� �xd
✓
Instcuctions: �ian.(�t a�' Qva/� Cirek
NCDOT Ptoject Mauagets/Engineexs, should complete the following checklist based upon youe
kno�vledge of tl�e pxoject site and imtnediate vicinity. If you check "Unable to Determine", effoits
should be undectaken to acquixe available inforuiarion on die pxoject If the answei to any question
is "Yes" oi "Unable to Deteiuune," the pioject is subject to fuxd�ex histouc pteseivation ieview, not
�vidistanding othei detexminations undex state envixonmental xeview laws and iegulations. If the
answex to all the questions is "No," die pxoject may be excluded from fuxtheL lustouc piesexvation
teview.
' Yes No UnaUle to
� - Detetmine
A. Does this pioject contain acuvities that ace not specifled in Appendix C of
the Nocth Carolina Pxogxammatic A�eemeM foi Minor Transpottation ✓
Ptojects? (List of Exempt Acuviues on teveise) .
B. Is tlils project dicectly :elated to othec actions with individually ,/
insignificant, but cumulatively significant, enviconmental effects? Y
C. t�e thece pzopezues listed on ot eligible Eot listing on the National Registet f
oE Historic Places in tl�e project acea? .
D. Is dus pcoject questioned by the o�vnet of a lilstoric pcopezty? �/
E. Is thete kno�vn public con[iovexsy based on historic presecvation issues? �
F. Can tlils pcoject be classiGed as anydilng otliec d�an a"categorical
exclusion" (or state-equivalent) pzoject
Cectification
By my signahue, I cettify diat I have completed a site visit ox am fainiliai widi the specifics of die
pioject aud d�at my answeis to the questions above aie, to the best of iny knowledge, couect. I also
undecstand diat no futthei envixonmental analysis is iequixed accoiding to Appendis C of flie Noxth
Cacolina Piogcammatie A�eement fox uior Tx�nspoitation Pxojects.
�n✓e /y�e�itniv // �/� //"""'t� b'3a-��

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� wm OP6xw�ou:e _ �s ♦♦
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USACE AID #:
NC SAM FIELD ASSESSMENT FORM
Accompanies User Manual Version 2
Rating Calculator Version 2
NCDWR #:
INSTRUCTIONS: Allach a sketch of the assessment area and photographs. Altach a copy af lhe USGS 7.5-minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If mulliple stream reaches will be evaluated on the same property,
identify and number all reaches on the altached map, and indude a separate form for each reach. See lhe NC SAM User Manual for
detailed descriptions and explanations of requested information. Record in the'Notes/Sketch' seclion if suppiementary measurements were
performed. See the NC SAM User Manuai for examples of additional measurements lhat may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATION:
1. Project name (if any): SR 1305 Qualla Road Repaving 2. Date oi evaluation: 7-1-16
3. ApplicanUowner name: NCDOT 4. Assessor name/organization: Dave McHenry
5. County: Clay 6. Nearest named waler body
7. River basin: Hiwassee River on USGS 7.5-minute quad: Qually Creek
8. Site coordinates (decimal degrees, at lower end of assessment reach): 35.054325, -83.826781
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): 1 10. Length oi assessment reach evaluated (feet): 100
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 5 ❑Unable io assess ch�
12. Channel width at top of bank (feet): 20 13. Is assessment reach a swamp steam? ❑Yes ❑No
14. Feature type: �Perennial flow ❑Intermiltent flow ❑Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
depth.
15. NC SAM Zone: � Mountains (M) ❑ Piedmont (P) ❑ Inner Coastai Plain (I) ❑ Outer Coastal Plain (0)
16.Estimatedgeomorphic �A\ V /
valley shape (skip for
Tidal Marsh Stream): (more sinuous sUeam, Flalter valley slope)
❑B`1�
(less sinuous stream, steeper valley slope)
17. Watershed size: (skip �Size 1(< 0.1 mi�) ❑Size 2(0.1 to < 0.5 miZ) �Size 3(0.5 to < 5 mi�) ❑Size 4(> 5 mi2)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
1S. Were regulalory considerations evaivated? �Yes ❑No If Yes, check all that appty to ihe assessment area.
❑Section 10 waler ❑Classified Troul Waters OWater Supply Watershed (�I ❑II ❑III �IV ❑V)
❑Essential Fish Habilat ❑Primary Nursery Area ❑ High Quality Waters/Outslanding Resource Waters
❑Publicly owned propeAy ❑NCDWR Riparian buffer rule in effect ❑NuUient Sensitive Waters
❑Anadromous fish ❑303(d) Lisi ❑CAMA Area of Environmenfal Concern (AEC)
❑Documenled presence of a tederal and/or state listed protected species within the assessment area.
List species:
❑Designaled Critical Habitat (list species)
Are additional stream informalioNsuo�lemf
1. Channel Water—assessment reach metric (skip for Size 1 slreams and T(dal Marsh Streams)
�A Water throughout assessment reach.
❑B No Flow, water in pools only.
❑C No water in assessment reach.
2. Evidence of Flow Restriction — assessmenl reach metric
❑A Al leasl 10% of assessment reach in-stream habitat or riffle-pool sequence is severely affected by a Flow restriction or fill to the
point of obslructing flow or a channel choked with aqualic macrophyles or ponded water or impoundment on Flood or ebb wilhin
the assessmenl reach (examples: undersized or perched culverts, causeways lhat constrict lhe channel, lidal gates, debris jams,
beaver dams).
�B NotA
3. Feature Paltern — assessment reach metric
❑A A majoriry of the assessment reach has allered patlem (exampies: slraightening, modification above or below culvert).
�B NotA
4. Fealure Longitudinal Profile—assessment reach met�ic
�A Majority of assessment reach has a substanlially altered stream profile (examples: channel down-cutling, existing damming,
over widening, adive aggradalion, dredging, and excavation where appropriate channel profile has not reformed from any ot
these disturbances).
❑B NotA
5. Sfgns of Active Instability— assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down-culting (head-cut), active widening, and artificiat hardening (such as concrele, gabioq rip-rap).
�A < 10°/a of channel unstable
❑B 10 l0 25% of channel unstable
�C > 25% of channel unstable

6. Slreamside Area Interaction — streamside area melric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
❑A �A LilQe or no evidence of conditions that adversely aifect reference inleraclion
❑B ❑B Moderale evidence of conditions (examples: berms, levees, down-cutting, aggredation, dredging) ihat adversely affect
reference inleraction (examples: limited streamside area access, disruption of Oood Oows lhrough slreamside area,
leaky or intermittent bulkheads, causeways with Floodplain constriction, minor ditching �including mosquito ditching))
�C OC EMensive evidence of conditions ihal adversely affect reference inleraction (little to no Floodplain/intertidal zone access
[examples: causeways with Floodplain and channel constriction, bulkheads, retaining walis, flll, stream incision,
disruption of Flood tlows through streamside area] or too much Floodplai�nterlidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplai�ntertidal zone unnalurally absent or assessment reach is a
man-made fealure on an interstream divide
7. Water Quality Stressors — assessment reach/intertidal zone metric
Check all that apply.
❑A Diswlored water in sfream or intertidal zone (milky white, blue, unnatural waler tliscoloration, oil sheen, stream foam)
�B Excessive sedimenialion (burying of stream features or inteAidal zone)
❑C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
❑D Odor (not including naturai sutfide odors)
❑E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in °Noles/Skelch"
seclion.
❑F Liveslock with access to stream or intertidal zone
�G Excessive algae in stream or intertidal zone
❑H Degraded marsh vegelation in lhe intertidal zone (removal, buming, regular mowing, destruclion, etc)
❑I Other: (explain in'Notes/Sketch' section)
�J Litlie to no stressors
8. Recent Weather—watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought for Size 3 or 4 sireams, D2 drought or higher is considered a
drought.
�A Drought conditions and no rainfall or rainfall not exceeding 1 inch wilhin lhe last 48 hours
❑B Droughl condilions and rainfail exceeding 1 inch within the last 48 hours
❑C No drought conditions
9. Large or Dangerous Stream — assessment reach metric
DYes �No Is stream is too large or dangerous lo assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In-stream Habitat Types —assessment reach metric
10a. �Yes ❑tJo Degraded in-stream habitat over majorily of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in-stream hardening [for example, rip-rap], recenl dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then sktp to Metric 72)
tOb. Check all that occur (occurs if> 5% coverage of assessment reachj (skip for Size 4 Coastal Plain slreams�
�A Multiple aquatic macrophytes and aquatic mosses � ❑F 5% oysters or other natura� hard bottoms
(include liverworts, lichens, and algal mats) F� ❑G Submerged aqualic vegelation
❑B Mutliple sticks and/or leaf packs and/or emergent F:'. ❑H Low-tide refugia (pools)
vegetation x t ❑I Sand bottom
❑C Muitiple snags and logs (inciuding lap trees) t; ❑J 5% vertical bank along the marsh
�D 5% undercut banks and/or root mats andlor roots �� ❑K Little or no habital
in banks extend to the normal welled perimeter
❑E Little or no habilat
'*"""""':*"'*"`•"""*•*•REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS"""'*""""""'"""`"""'
11. Bedform and Substrate —assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Slreams)
17a. ❑Yes �No Is assessment reach in a natural sand-bed siream? (skip for Coastal Plain streams)
11b. Bedform evaluated. Check the appropriate box(es).
�A Riffle-run section (evaluate 11c)
�8 Pool-glide section (evaluate 11d)
❑C NaWral bedform absent (skip to Metric 12, Aquatic Life)
71c. In riPoe sections, check all that occur below ihe normal wetted perimeter of the assessment reach — whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but < 10%, Common (C) _> 10-40%, Abundant (A) _> 40-70%, Predominant (P) _> 70%. Cumufative
percentages should not exceed 100% for each assessment reach.
NP R C A P
� ❑ ❑ ❑ ❑ Bedrock/saprofite
� ❑ ❑ ❑ ❑ Boulder (256 — 4096 mm)
❑ � ❑ ❑ ❑ Cobble (64 — 256 mm)
❑ ❑ � ❑ ❑ Gravel(2-64mm)
❑ ❑ ❑ � ❑ Sand (.062 — 2 mm)
❑ ❑ � ❑ ❑ SilUGay (< 0.062 mm)
� ❑ ❑ ❑ ❑ Detritus
� ❑ ❑ ❑ ❑ AAificial (rip-rap, concrete, etc.)
11d. �Yes �No Are pools fllled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)

12. Aquatic Life — assessment reach metric (skip for Tidal Marsh Streams)
12a. �Yes ❑No Was an in-stream aquatic life assessment performed as described in lhe User Manual?
If No, select one of ihe following reasons and skip lo Metric 13. ❑No Water ❑Olher:
12b. �Yes ❑No Are aquatic organisms present in the assessment reach (look in riffles, pools, lhen snags)? If Yes, check all that
apply. If No, skip to Metric 13.
t >1 Numbers over columns refer to'individuals' for Size 1 and 2 sireams and °taxa for Size 3 and 4 streams.
❑ �Adult frogs
❑ ❑Aqualic reptiles
❑ �Aquatic macrophytes and aquatic mosses (include IiverwoAs, lichens, and algal mats)
❑ ❑Beetles
❑ �CaddisFly larvae (T)
❑ ❑Asian clam (Coibicula)
❑ ❑Crustacean (isopod/amphipod/crayfish/shrimp)
❑ ❑Damselfly and dragonfly larvae
❑ ❑Dipterans
❑ �Mayfly larvae (E)
❑ ❑Megaloptera (alderfly, fish0y, dobsonFly larvae)
❑ ❑Midges/mosquito larvae
❑ ❑Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
❑ ❑Mussels/Clams (not Cor6icula)
❑ ❑Otherfish
❑ ❑Salamandersltadpoles
❑ �Snails
❑ ❑Stonefly larvae (P)
❑ ❑Tipulid larvae
❑ ❑WormsAeeches
13. Streamside Area Ground Surface Condition — streamside area melric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider slorage capacily with regard to both overbank Flow and upland
runoff.
LB R8
❑A ❑A Liqle or no alteration to water slorage capacity over a majority of the streamside area
❑B �B Moderate alteralion to water storage capacity over a majority of the slreamside area
�C ❑C Severe alteration to water storage capacity over a majority of the streamside area (examp�es: ditches, fill, soil
compaction, liveslodc disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Size 7 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
❑A ❑A Majorify o( streamside area with depressions able to pond waler Z 6 inches deep
❑B ❑B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
�C �C Majority o( streamside area with depressions able to pond waler < 3 inches deep
15. Wetland Presence—slreamside area metric (skip forTidal Marsh Streams)
Consider for the Lek 6ank (LB) and the Right Bank (RB). Do not consider wetlands outside of lhe streamside area or wilhin the normal
welted perimeter of assessment reach.
LB RB
QY ❑Y Are wetlands present in the slreamside area?
�N �N
16. Baseflow Contributors — assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and dralnfng to the assessment reach.
�A Streams and/or springs (jurisdicfionai discharges)
❑B Ponds (include wet detenlion basins; do not include sedimenl basins or dry delention basins)
❑C Obstruction passing Flow during low-flow periods wilhin lhe assessment area (beaver dam, leaky dam, boQom-release dam, weir)
�D Evidence of bank seepage or sweating (iron in water indicates seepage)
❑E Sfream bed or bank soif reduced (dig through deposited sediment if present)
❑F None of lhe above
17. Baseflow Det�actors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
❑A Evidence of substantial waler withdrawals hom the assessment reach (includes areas excavaled for pump installation)
❑8 Obstruction not passing ilow during low-flow periods affecting lhe assessment reach (ex: watertighl dam, sediment deposit)
�C Urban stream (>_ 24% impervious surface for watershed)
�D Evidence lhat lhe streamside area has been modified resNling in accelerated drainage into the assessmenl reach
�E Assessment reach relocated to valley edge
�F None of the above
18. Shading — assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect Consider'leaf-on' wndition.
❑A Stream shading is appropriate for sUeam category (may include gaps associated with natural processes)
�B Degraded (example: scattered Irees)
❑C Stream shading is gone or Iargely absent

19. Buffer Width — slreamside area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
Vegetated Wooded
LB RB LB RB
❑A ❑A �A ❑A ? 700 feet wide or e�ctends to ihe edge of the watershed
❑B ❑B ❑B ❑B From 50 to < 100 feet wide
❑C ❑C ❑C ❑C From 30 to < 50 feet wide
❑D �D ❑D �D From 10 to < 30 teet wide
�E ❑E �E ❑E < 10 feet wide or no trees
20. Buffer Structure— streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
❑A �A Mature forest
❑B �B Non-mature woody vegetation or modified vegeialion sVucture
�C ❑C Herbaceous vegetalion with or without a sUip of lrees < 10 feet wide
❑D ❑D Mainlained shrubs
❑E ❑E Litlle or no vegetalion
21. Buffer Stressors —streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes Tor lek bank (LB) and right bank (RB). Indicate if listed slressor abu[s slream (Abuls), does not abut but
is within 30 feet of stream (< 30 feet), or is belween 30 to 50 feet of stream (30-50 feel).
If none of the following stressors accurs on either bank, check here and skip to Metric 22: ❑
Abuts < 30 feet 30-50 teet
LB RB LB RB LB RB
❑A �A �A �A ❑A ❑A Row crops
�B ❑B ❑B ❑B ❑B ❑B Maintained lurf
pC pC ❑C �C ❑C ❑C Pasture (no livestock)/commerciai horticulture
❑D ❑D ❑D ❑D ❑D ❑D Paslure (active liveslock use)
22. Stem Density—streamside area metric (skip forTidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
❑A ❑A Medium lo high stem density
❑B �B Low stem densily
�C ❑C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer— streamside area metric (skip for Tidal Marsh Streams)
Consider whelher vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
LB RB
�A ❑A The total length of buffer breaks is < 25 percent.
❑B �B The tota� length of buffer breaks is belween 25 and 50 percent.
�C ❑C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition—streamside a�ea metric (skip forTidal Marsh Streams)
Evaluale lhe dominant vegetalion wilhin 100 feet of each bank or lo ihe edge of the watershed (whichever comes firsi) as it coniributes to
assessmenl reach habital.
LB RB
❑A DA Vegetation is ciose to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-nalive invasive species absenl or sparse.
❑B �B Vegetation indicates disturbance in terms of species diversity or proporiions, but is slill largely composed of nafive
species. This may inciude communifies ot weedy native species that develop after clear-cutling or clearing or
communities with non-native invasive species present, but not dominanf, over a large portion of the expected strata or
communilies missing underslory but retaining canopy trees.
�C ❑C Vegelalion is severely disWrbed in terms of species diversity or propodions. Mature canopy is absent or communities
wilh non-nalive invasive species dominanl over a large portion of expected slraia or communities composed of planted
stands of nomcharacteristic species or communities inapproprialely composed of a single species or no vegetalion.
25. Conductivity — assessment reach metric (skip for aIl Coastal Plain streams)
25a. �Yes �No Was conductivily measurement recorded?
If No, select one of lhe following reasons. ❑No Water ❑Other:
25b. Check the box corresponding to the conductiviry measurement (units of microsiemens per centimeter).
❑A <46 ❑B 4610<67 ❑C 67to<79 ❑D 79to<230 ❑E ?230
Notes/Skelch:

Draft NC SAM Stream Rating Sheet
Accompanies User Manual Version 1
Rating Calculator Version 2
Stream Site Name SR 1305 Qualla Road Dale of Assessment 7-1-16
Repaving
Slream Category Ma3 Assessor Name/Organization Dave McHenry
Notes of Field Assessment Form (Y/N) NO
Presence of reguiatory considerations (Y/N) NO
Additionai slream information/supplementary measurements included (Y/N)
NC SAM feaiure type (perennial, intermittent, Tidal Marsh Stream) Perennial
USACE/ NCDWR
Function Class Rating Summary All Streams Intermittent
(1) Hydrology LOW '
(2) BaseFlow HIGH
(2) Flood Flow LOW
(3) Slreamside Area Altenualion LOW
(4) Floodplain Access MEDIUM
(4) Wooded Riparian Buffer LOW
(4) Microtopography LOW
(3) Slream Stabi�ily LOW
(4) Channel Slabi�ity LOW
(4) Sediment Transport ME�IUM
(4) Stream Geomorphofogy MEDIUM
(2) Slream/Intertidal Zone Interaclion NA
(2) Longitudinal Tidal Flow NA
(2) Tidal Marsh Stream Stability NA �
(3) Tidal Marsh Channel Stability NA
(3) Tidal Marsh Stream Geomorphology NA
(1) Water Quality LOW
(2) Baseflow HIGH
(2) Sireamside Area Vegetation LOW . �
(3) Upiand Pollutant Filtration LOW � �
(3) Thermoregulation MEDIUM '
(2) Indicators of Stressors YES
(2) Aquatic Life Tolerance HIGH
(2) Intertidal Zone Filtration NA
(1) Habitat LOW �
(2) In-stream Habitat LOW
(3) Baseilow HIGH
(3) Substrate MEDIUM �
(3) Stream Stability LOW
(3) In-stream Habitat LOW
(2) Slream-side Habitat LOW
(3) Stream-side Habitat LOW �
(3) Thermoregulation MEDIUM '
(2) Tidal Marsh In-stream Habitat NA
(3) Flow Restriction NA
(3) Tidal Marsh SUeam Slability NA
(4j Tidal Marsh Channel Slability NA �.
(4) Tidal Marsh Stream Geomorphology NA
(3) Tidal Marsh In-stream Habitat Nq
(2) Intertidal Zone Nq
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Site 26b and 26c Qually Creel< relocation area facing upstream (SW) from SR 1305 shoulder. Channel
relocation proposed on bench and bank behind tree with vines.
(Due to steep drop, Site 26 culvert outlet is not visible in bottom center of photo below flagged stake.)